English: Figure 1. The pathophysiology of Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) syndrome involves an autoimmune response triggered by a streptococcus infection. The presence of neuroinflammation in the dorsal striatum can result in the disruption of cholinergic activity. This disruption can lead to an imbalance between the direct and indirect pathways within the basal ganglia. Consequently, off-target behaviors such as tics, obsessions, and compulsions may be disinhibited. Notably, the hyperactivity of the direct pathway in relation to motor and limbic domains has been linked to these behaviors (created with BioRender.com). Abbreviations. Ach: acetylcholine, MSNs: medium-sized spiny neurons.